What weight loss drugs will Medicare pay for?

For weight loss alone, none under the standard Part D benefit, which excludes weight-loss drugs by statute. Medicare pays for the same drugs under another indication — Ozempic (injection or tablet), Rybelsus and Mounjaro for type 2 diabetes, Wegovy for cardiovascular risk reduction or the liver disease MASH, Zepbound for moderate to severe obstructive sleep apnea — and, through the GLP-1 Bridge demonstration from 1 July 2026 to 31 December 2027, Wegovy, Foundayo and the Zepbound KwikPen for obesity at $50 a month, with a prior authorization. A plan with enhanced coverage may also add excluded drugs as a supplemental benefit. The exclusion itself stands: CMS proposed reinterpreting it in November 2024 to treat obesity as a chronic disease, and did not finalize that when it published the 2026 rule on 4 April 2025.

What if the answer is no?

Paying cash is a separate transaction with its own price, and it does not touch a deductible. The cheapest verified price on this site for a GLP-1 medication itself, rather than a telehealth program, is Foundayo at $299 a month (boxed warning). Every route with a verified price is ranked in the price table linked above.

← Does insurance cover it

Does Medicare cover Ozempic, Wegovy or Zepbound?

Not for weight loss, and the reason is statutory rather than a plan decision: the Social Security Act excludes agents used for weight loss from the Part D benefit. Everything below is about the routes around that exclusion: a different indication on the label, the GLP-1 Bridge demonstration, or a plan that adds excluded drugs as a supplemental benefit.

Does Medicare cover Zepbound or Wegovy?

Medicare is not one plan either, but it is the one payer on this site whose rule for weight-loss drugs is written in statute rather than chosen by an employer, so its standard answer is the same for everyone. For weight alone the standard Part D benefit is closed by statute; what remains is a different indication, the GLP-1 Bridge, or a plan that adds excluded drugs as a supplemental benefit. If the answer is no, that is a price question rather than a coverage one. The cheapest verified cash price on this site for a GLP-1 medication itself is Foundayo at $299 a month (boxed warning). That figure was read from its own published page on 2026-09-12, and paying cash does not touch a deductible. The indication written on the prescription decides more than the plan does — sleep apnea and cardiovascular risk are separate FDA-approved indications, and an exclusion written against weight loss does not reach them. Each of the 5 cases below says who makes the call and which document records the decision.

What is actually knowable

Part D excludes weight-loss drugs by statute
Section 1927(d)(2) of the Social Security Act lists drugs used for weight loss among those a program may exclude, and Part D adopted that exclusion. CMS proposed reinterpreting it in November 2024 to recognize obesity as a chronic disease and did not finalize that in April 2025, so the standard Part D benefit still cannot cover a GLP-1 prescribed for weight alone, however the paperwork is written. A plan with enhanced coverage may add excluded drugs as a supplemental benefit, and its Evidence of Coverage says whether it has.
Social Security Act §1927(d)(2), which lists “agents when used for anorexia, weight loss, or weight gain” among the drugs a program may exclude
The Medicare GLP-1 Bridge runs 1 July 2026 to 31 December 2027, at $50 a month
A CMS demonstration under Section 402 authority, not a Part D benefit. It covers all formulations of Foundayo and Wegovy and the KwikPen formulation of Zepbound, for Part D beneficiaries whose prescriber submits a prior authorization attesting the drug treats obesity. The catch is structural: because it sits outside Part D, the $50 counts toward neither your deductible nor the out-of-pocket maximum.
Medicare GLP-1 Bridge, CMS
A different indication is covered, and it is the route most people miss
The exclusion is about the indication, not the molecule. Semaglutide for type 2 diabetes — Ozempic as the injection or the tablet, or Rybelsus — and tirzepatide for the same, which is Mounjaro rather than Zepbound, are coverable under Part D on that indication, as are Wegovy for cardiovascular risk reduction and Zepbound for moderate to severe obstructive sleep apnea. None of them is 'used for weight loss' in the statute's sense. For diabetes the brand is what changes: the same molecule is excluded as Wegovy or Zepbound and covered as Ozempic or Mounjaro. For heart disease and sleep apnea the brand stays and the indication changes, on the same label. If one of those applies to you, the question at a denial is which indication was written, not whether Medicare covers the drug.
Social Security Act §1927(d)(2), which lists “agents when used for anorexia, weight loss, or weight gain” among the drugs a program may exclude
Manufacturer copay cards cannot be used with Medicare at all
Federal anti-kickback rules bar a manufacturer from subsidizing a copay inside a federal health program. Every '$25 card' in this category says 'commercially insured' for that reason, and it is why the Bridge exists as a separate route rather than as a card.
HHS Office of Inspector General on manufacturer copayment coupons in Part D

One drug at a time

The answer changes with the brand, because Medicare excludes a use rather than a molecule: which indication each one carries, whether the GLP-1 Bridge lists it, and what it costs if neither applies.

It depends on your plan — on which of these five

None of these states whether you are covered. Each says who makes that decision for that plan type and which document records it, because those two facts are knowable and the verdict is not.

Standalone Part D drug plan (PDP)

Who decides: Statute, before the plan gets a say. Part D's definition of a covered drug leaves out the uses section 1927(d)(2) lets a program exclude, weight loss among them, so a PDP's basic benefit cannot cover a GLP-1 for weight alone, however the prior authorization is worded. A plan with enhanced coverage may add excluded drugs as a supplemental benefit.
What settles it: Your plan's Part D formulary for the non-weight indications below, and its Evidence of Coverage for whether it adds any excluded drug as a supplemental benefit.
Worth knowing: For weight, a 'no' here comes from the statute rather than the plan in every standard plan. The one exception is a supplemental benefit a plan chooses to add, and its Evidence of Coverage is where that would be written.
The clock: 72 hours for a standard coverage determination and 24 for an expedited one; for an exception the clock starts when the prescriber's supporting statement arrives. 60 days from the notice to ask the plan for a redetermination, longer if you show good cause. 42 CFR 423.568; 42 CFR 423.572; 42 CFR 423.582

Medicare Advantage with drug coverage (MA-PD)

Who decides: The same statute. An MA-PD plan's drug benefit is Part D, so the exclusion travels with its basic benefit. The opening is the same as a standalone plan's: enhanced Part D coverage may add an excluded drug as a supplemental benefit, and the Evidence of Coverage would list it.
What settles it: The plan's Evidence of Coverage, which will state the exclusion, plus its Part D formulary for the covered indications.
Worth knowing: A plan advertising 'weight management support' is offering coaching or meal programs, not the drug. Read what the benefit actually is before switching plans for it.
The clock: 72 hours for a standard coverage determination and 24 for an expedited one; for an exception the clock starts when the prescriber's supporting statement arrives. 60 days from the notice to ask the plan for a redetermination, longer if you show good cause. 42 CFR 423.568; 42 CFR 423.572; 42 CFR 423.582

Part B (medical benefit)

Who decides: Not applicable, and this is the most common misunderstanding in the category. Part B covers drugs administered in a clinical setting; a self-injected pen dispensed by a pharmacy is a Part D drug regardless of how it is prescribed.
What settles it: None to read — the question does not arise under Part B.
Worth knowing: If a site tells you to ask about Part B coverage for Wegovy or Zepbound, it does not know how the benefit is split.

Dual eligible — Medicare and Medicaid together

Who decides: Your state. Part D still excludes the weight indication, but state Medicaid programs may cover anti-obesity medication as an optional benefit, and a minority do.
What settles it: Your state's Medicaid preferred drug list and its prior approval criteria, not the Part D formulary.
Worth knowing: This is the single plan type where the answer changes with your address rather than your plan, and halfrx lists every state's status with the document it was read from.
The clock: Federal Medicaid law requires an answer to a drug prior authorization within 24 hours, and a 72-hour emergency supply while it is pending. In a managed care plan you have 60 days from a denial to appeal to the plan, which must decide within 30 days, or 72 hours if it is urgent. On a decision the state makes itself, it may allow up to 90 days to ask for a fair hearing. Social Security Act §1927(d)(5); 42 CFR 438.402; 42 CFR 438.408; 42 CFR 431.221

Medicare GLP-1 Bridge demonstration

Who decides: CMS, under Section 402 demonstration authority — deliberately outside Part D, which is how it sidesteps the exclusion rather than overturning it.
What settles it: The CMS demonstration page, and a prior authorization from your prescriber attesting the drug treats obesity.
Worth knowing: Because it sits outside Part D, the $50 counts toward neither your deductible nor your out-of-pocket maximum. It runs 1 July 2026 to 31 December 2027.

The forms Medicare publishes

Linked, never copied here. A prior authorization form is revised without notice, and a republished copy is how a superseded version ends up in a submission.

Model Coverage Determination Request Form, CMS
The form a Part D plan must accept for a coverage determination or exception request. CMS publishes it as a zip with the instructions; plans may use their own version, and yours must accept this one.
Exceptions, CMS
What a formulary exception is, and the deadlines a plan is held to: 72 hours for a standard request, 24 for an expedited one, counted from when the prescriber's supporting statement arrives rather than from your call.
Model Redetermination Request Form, CMS
The first-level appeal after a denial, effective 1 January 2025. You have 60 days from the denial notice.

How do I check if Medicare covers my GLP-1?

1Check which indication your prescription was written under. That single line decides more than the plan does.
2If it is obesity alone, check eligibility for the GLP-1 Bridge — it is the only route CMS currently offers for that indication.
3Look up your specific Part D plan's formulary for the diabetes, cardiovascular or sleep-apnea indication if one applies to you.

Then take the criterion it gives you to the prior authorization pack or, at a denial, the appeal letter builder. Both run entirely in your browser and send nothing anywhere.

If the answer is no, this is the price

Cheapest verified cash routes, each with its source and the date it was read. Paying cash does not touch a deductible or an out-of-pocket maximum — which cuts both ways.

Route	A month	What it is	Checked
Foundayo	$299	branded, FDA approved; boxed warning	2026-09-12
Wegovy pill	$299	branded, FDA approved; boxed warning	2026-09-10
Ozempic	$349	branded, FDA approved; off-label for weight; boxed warning	2026-09-22
Wegovy	$349	branded, FDA approved; boxed warning	2026-09-22

How each kind of plan works →Medicaid, by state →Prior authorization pack →Which approval a plan cannot exclude →Which coupons you can actually use →Appeal a denial →Every verified price, ranked →

The other payers we hold criteria for

Each read from that plan's own published policy, with the date on the document. A plan that excludes weight-loss drugs may still cover the same molecule under a different indication, which is the distinction that decides most denials.

The law this page rests on

What a plan chooses and what a statute forbids are different questions. These are the documents behind the second.

Social Security Act §1927(d)(2), Office of the Law Revision Counsel — The statute itself, listing “agents when used for anorexia, weight loss, or weight gain” among the drugs a program may exclude.
Manufacturer safeguards may not prevent copayment coupon use for Part D drugs, HHS Office of Inspector General — Why a manufacturer copay card cannot be used with a federal program, from the office that enforces it.
Weight-loss drugs, Medicare.gov — Medicare's own page on what it does and does not cover for weight loss.

Medicare coverage, answered

Does Medicare cover Zepbound?: Medicare is not one plan either, but it is the one payer on this site whose rule for weight-loss drugs is written in statute rather than chosen by an employer, so its standard answer is the same for everyone. For weight alone the standard Part D benefit is closed by statute; what remains is a different indication, the GLP-1 Bridge, or a plan that adds excluded drugs as a supplemental benefit.
What weight loss drugs will Medicare pay for?: For weight loss alone, none under the standard Part D benefit, which excludes weight-loss drugs by statute. Medicare pays for the same drugs under another indication — Ozempic (injection or tablet), Rybelsus and Mounjaro for type 2 diabetes, Wegovy for cardiovascular risk reduction or the liver disease MASH, Zepbound for moderate to severe obstructive sleep apnea — and, through the GLP-1 Bridge demonstration from 1 July 2026 to 31 December 2027, Wegovy, Foundayo and the Zepbound KwikPen for obesity at $50 a month, with a prior authorization. A plan with enhanced coverage may also add excluded drugs as a supplemental benefit. The exclusion itself stands: CMS proposed reinterpreting it in November 2024 to treat obesity as a chronic disease, and did not finalize that when it published the 2026 rule on 4 April 2025.
What if the answer is no?: Paying cash is a separate transaction with its own price, and it does not touch a deductible. The cheapest verified price on this site for a GLP-1 medication itself, rather than a telehealth program, is Foundayo at $299 a month (boxed warning). Every route with a verified price is ranked in the price table linked above.

Everything above is either a structural fact about how this payer works or a quotation from a document linked beside it, with its scope stated. Information only, not medical or insurance advice.